**Overview** The **Appeals and Grievance Specialist** will be responsible for managing, coordinating, and resolving member and provider complaints, grievances, and appeals, ensuring compliance with state and federal regulatory requirements. Our **Appeals and Grievance Specialist** will act as the primary investigator and contact person for the member and provider and perform research, resolution, and response to complaints on behalf of a member. **Responsibilities** + Sending appropriate acknowledgment of the grievance/appeal; educating the member or provider about the grievance/appeal process and their right to appeal to state or federal agencies (if applicable) + Gathering all relevant information from the member or provider regarding the grievance/appeal and determining the appropriate resolution of the grievance/appeal per standard policies and procedures. + Notifying the appropriate parties of the resolution and ensuring that all internal processes are completed to resolve the issue + Conducts non-biased, accurate, timely, and comprehensive investigation of all the facts related to the grievance/appeal + Thoroughly documents all action taken on behalf of the member or provider to resolve the grievance/appeal. + Ensures that all grievances/appeals are processed in adherence to state and federal regulations **Qualifications** + 1+ years of Medicare Appeals/Grievance experience or Medicare Claims experience required + Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications + Must have strong technical skills (Microsoft Windows, keyboarding skills, strong systems aptitude, etc.) + Excellent verbal and written communication skills + Ability to remain focused and productive each day though tasks may be repetitive + High school diploma or equivalent **Preferred Qualifications** + Processing Medicare Appeals/Grievance with Medicare Part C or D experience **Diversity Statement** At BroadPath, diversity is our strength. We embrace individuals from all backgrounds, experiences, and perspectives. We foster an inclusive environment where everyone feels valued and empowered. Join us and be part of a team that celebrates diversity and drives innovation! Equal Employment Opportunity/Disability/Veterans If you need accommodation due to a disability, please email us at HR@Broad-path.com. This information will be held in confidence and used only to determine an appropriate accommodation for the application process BroadPath is an Equal Opportunity Employer. We do not discriminate against our applicants because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age, disability, veteran status, genetic information, or any other status protected by applicable law. **Compensation:**  BroadPath has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.